NHS Direct patient database approaches first birthday

NHS Direct, the health service’s telephone and online advice service will celebrate the first birthday of its single national database next month, launched in partnership with clinical decision support software (CDSS) specialists, Clinical Solutions.

The database records all individual patients who contact the NHS Direct phoneline and holds details of their enquiry and any advice given.

As part of the move to the single patient database CAS Clinical Solutions consolidated all NHS Direct’s five million patient records into one single database and upgraded its call centres.

Faster service dealing with enquiries, easier analysis of symptoms and faster treatment advice are just some of the benefits NHS Direct says it has gained from the new patient database.

In October 2000, when NHS Direct launched as a national service, NHS Direct introduced its national clinical decision support system for its call centres. The system allowed users to read questions from the software to the patient to get a response and offer treatment advice.

Dr Mike Sadler, chief operating officer and medical director at NHS Direct told E-Health Insider that while the CDSS was working well in dealing with the calls coming through, they felt the need to create electronic patient records (EPRs) for the calls that were coming through so that there was a clear record of what guidance was given to the patient.

“We originally used a bespoke CDSS system that showed staff a series of questions to ask patients who phoned up, based on a current NHS knowledge base. Staff would then give the patient the guideline advice based on the software’s findings, but not record information that could be shared.”

He added that the aim of the project was to create a national database that would create single patient records and store them.

“We wanted to be able to create a new system that would allow staff to create one record for each patient that would be accessible across the service, and would offer continuity of care, limiting the need for training and avoiding the need for duplicating data.”

Once the call has been answered, nurses benefit from Clinical Solutions’ ‘jump’ technology, which allows them to quickly move to the most relevant algorithms.

NHS Direct launched its single database system across the service last November and Dr Sadler says the switch to a new electronic patient record and clinical decision support system was controversial, but worthwhile.

The project was part of NHS Direct’s overall strategy to create a virtual contact centre where patient enquiries can be easily handled anywhere.

“Moving from our CDSS, which was hugely popular and earned us NAO praise was a risk, but it has been worthwhile. As we grow we will see more importance in our system. It has already helped us deal with calls faster, by allowing staff to sort patient symptoms categorically and offer treatment advice faster, whilst the database saves all the information taken.”

A spokesperson for Clinical Solutions said: “By introducing a single patient database within Clinical Solutions, staff can work from shared call queues across locations.”

They added that all sites now have easy access to the service and so the risk of duplicating risks was minimal.

“This provides an even safer and more effective way of responding to patients’ calls.”

Sadler said that there were barriers to the switch, but the benefits seen have made it worthwhile.

“Staff were loyal to the CDSS and did not like having to change previous working habits to adopt to the new database, but a year on, the benefits of the new system are clearly visible to both staff and clinicians whom we can now share patient information with.”

NHS Direct are now in talks with Connecting for Health over integrating their system with the new systems being delivered by local service providers to the NHS in England and Dr Sadler hopes this can be achieved by 2007-2008.

“Integrating our system and allowing interoperability with the systems being implemented by CfH would be ideal for ensuring continuity of patient care based on integrating our care records and those stored in trust systems. Carers must be kept informed of their patients’ progress.”

One area where NHS Direct is keento expand its work is with the management of long-term illnesses, and the implementation of telemedicine.

“Almost a third of the population has a long term condition and we need to be able to care for them as much as possible. GPs do not currently have enough time to continually monitor patients with these conditions, on average one will get about 3 hours each year in total with their GP, some not even that much time," said Dr Sadler. 

“This simply isn’t enough time; we need more resources to deal with this barrier. Patients and carers need to make the most of technology that can help them deal with their illnesses. NHS Direct supports the call to provide patients with the tools to enable them to self-diagnose with remote assistance and would like to support more patients who opt to use telemedicine as a treatment method.”

So, after a successful year on a national database connecting all 22 of its call centres, what advice can Dr Sadler offer to other businesses looking to implement a large-scale PAS?

“Businesses must specify their requirements clearly during implementation and constantly check the functional specification through ongoing dialogue with developers; otherwise the technology just can’t be delivered right.”

The flagship telephone and online advice service, which was launched in 1998, currently takes seven million phone calls each year, with 20m people visiting the NHS Direct website annually.

NHS Direct also publishes a self-help guide in the Thomson directories, which are distributed to 18m people and has an interactive service with satellite and cable digital TV providers, subscribed to by 7m people.